Afghan Province, Squeezed by Taliban, Loses Access to Medical Care

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Health workers vaccinating children for polio in Kandahar, Afghanistan. A vaccination campaign in nearby Oruzgan Province will be delayed because clinics there have closed under pressure from the Taliban, officials say.CreditCreditMuhammad Sadiq/European Pressphoto Agency

KANDAHAR, Afghanistan — Muhammad Anwar, 8, was vomiting all night and had severe diarrhea. His father, Hajji Aslam, did not know what to do.

Most, and perhaps all, of the clinics in Oruzgan Province in southern Afghanistan are shut, including the one in their village, Shawali Karez. The province remains largely controlled by the Taliban, who are tightening their noose around the provincial capital, Tirin Kot.

So Mr. Aslam carried his barely conscious child in his arms, hitchhiked on the back of a tractor and arrived on Saturday in Tirin Kot at the gates of the only hospital said to be still open. The 100-bed facility is just down the road from the provincial administrative offices.

But the gates of that hospital, too, were shut. A crowd of people waited in vain.

“I brought him from my village to the central hospital expecting treatment, but found it closed and the reason they said that is the Taliban are threatening them,” Mr. Aslam said. “Maybe God does not like our deeds and that is why we are put through such misery and suffering.”

Mr. Aslam said he waited for 20 minutes, then left when he was told that the hospital would not open. He took his child to the house of a friend who lives in the city. “He brought some medication for my sick son,” Mr. Aslam said.

Officials in Oruzgan said that a rising Taliban threat in recent weeks had left the government no choice but to shut the clinics — all of them, according to some accounts, or 46 of the 49 operating in the province, other reports said — and then on Saturday the only remaining hospital. (Later in the day, the hospital’s emergency services branch was reopened.)

“The Taliban have closed all district health clinics and sent us threats to shut down the hospital, too, so the doctors decided to close it down for their own safety,” said Khan Agha Miakhel, director of the provincial health department in Oruzgan.

Mr. Miakhel said the Taliban were demanding that the government select only health officials recommended by their insurgent movement, and that they select the locations of any new clinics. Other officials said the Taliban also wanted the government to send surgeons and medical supplies to district clinics to care for wounded insurgents.

In the face of the Taliban pressure, the provincial government seemed helpless.

“We are working closely with elders and influential people around the province to convince the Taliban not to bring health affairs into politics,” said Dost Mohammad Nayab, a spokesman for the governor of Oruzgan.

Zabihullah Mujahid, a Taliban spokesman, denied that the insurgents had made any threats and said that the clinics had “collapsed” because of government incompetence and corruption.

“All the clinics and the hospital in Oruzgan, they have no facilities — no medicine, no doctors, no personnel,” Mr. Mujahid said. “They just keep some guards and cleaners for salary. There is nothing medical.”

As the Afghan war continues to rage, with varying degrees of fighting in 20 of the country’s 34 provinces, health workers have found that the places where they can function are shrinking. They have repeatedly come under attack, forcing many clinics and aid groups to reduce their operations or limit their movements. This month, a physiotherapist working for the International Committee of the Red Cross was shot by a gunman in a wheelchair who had been treated for polio at the same orthopedic center in northern Afghanistan for 19 years.

In places like Oruzgan, where the government’s control has been reduced to the capital and areas just beyond it in recent years, residents are stuck between an administration that cannot protect its population and deliver services, and a violent insurgency that cannot meet even their most basic survival needs.

Although official statistics in Afghanistan are often unreliable, figures from the Central Statistics Organization in 2012-13 put Oruzgan’s population at about 333,500. Mr. Nayab, the governor’s spokesman, said the number could be more than double that.

Mr. Aslam, the father of the child who was turned back from the hospital, said that although the fighting in Oruzgan had forced his family to move 15 times in less than an year, he had put up with it. But watching his son suffer in his arms was too much.

“Now a minor illness can lead to death,” he said. “If the government is not able to secure the hospital, which is next to the governor’s house, how would they be able to secure us in the villages?”

Christine Monaghan, a research officer at Watchlist, said that without a hospital in Oruzgan, “children who are already malnourished can’t get basic services.” She added that “pregnant women can’t get any type of services that they need.”

The war not only threatens children who need immediate care, but also endangers those at risk of disease. Afghanistan remains one of the few countries still reporting cases of polio, and a crucial national campaign planned for this week to vaccinate children against the disease will have to be delayed in Oruzgan.

“The polio drive is postponed until the issue has been resolved with the Taliban,” said Amir Muhammad Barakzai, the leader of the provincial council.